PERAC Memo #14 - 2007: 840 CMR 10:10(3) & 10:15(4)–Annual Review of Medical Testing Fees

840 CMR 10:10(3) & 10:15(4)–Annual Review of Medical Testing Fees

Summary

This memo confirms PERAC's annual review (as required by 840 CMR 10:10(3) & 10:15(4)) of the cost cap for non-invasive medical tests ordered by Regional Medical Panels. The Commission voted on January 24, 2007 to maintain the existing $100 per-case limit that PERAC staff may approve without further Commission authorization. No action is required by boards, but they should be aware that any panel-ordered test exceeding $100 requires advance PERAC approval.

Full Text

Memorandum # 14/2007

M E M O R A N D U M TO: All Retirement Boards FROM: Joseph E. Connarton, Executive Director RE: 840 CMR 10:10(3) & 10:15(4)–Annual Review of Medical Testing Fees

DATE: February 2, 2007

As you know, 840 CMR 10:10(3) and 10:15(4) states “the medical panel may suggest ‘non-invasive’ medical tests, which the panel considers necessary to render an opinion of the member’s medical condition. The regulation further states that the Commission shall assume the cost of any non-invasive test suggested by the medical panel up to an amount that the Commission shall determine annually. This annual determination will be communicated to all retirement boards during the month of January. No test, the cost of which exceeds the annual amount determined by the Commission, shall be ordered or required by the medical panel without the advance approval of the Commission”.

There are very few instances where reimbursements for medical services ordered by a Regional Medical Panel exceed $100. Medical panel physicians conduct very few medical tests during the examination process. The member’s medical provider generally orders the necessary medical tests during the evaluation and treatment phase, and provides this information to the Regional Medical Panel. The Regional Medical Panel physicians consider the results of these studies as part of the panel examination.

Please be advised at their meeting held January 24, 2007, the Commission voted to continue the past practice of allowing PERAC staff to approve up to $100.00 per case for non-invasive medical testing associated with the medical panel process.

If you have questions, please contact PERAC’s Disability Unit at 617-666-4446 ext. 956.